Plasma von Willebrand Factor Levels Correlate with Clinical Outcome of Severe Traumatic Brain Injury

Abstract

Biochemical markers of cellular stress/injury have been proposed to indicate outcome after head injury. The aim of the present study was to determine whether plasma von Willebrand factor (VWF) levels correlate with primary outcome and with clinical variables in severe traumatic brain injury (TBI). Forty-four male patients, victims of severe TBI, were analyzed. Clinical outcome variables of severe TBI comprised survival and neurological assessment using the Glasgow Outcome Scale (GOS) at intensive care unit (ICU) discharge. Computerized tomography (CT) scans were analyzed according to Marshall CT classification. Three consecutive venous blood samples were taken: first sample (11.4 +/- 5.2 h after trauma, mean +/- SD), and 24 h and 7 days later. The result of mean plasma VWF concentration was significantly higher in the TBI group (273 U/dL) than in the control group (107 U/dL; p < 0.001). Severe TBI was associated with a 50% mortality rate. Nonsurvivors presented significantly higher APACHE II scores than survivors (nonsurvivors mean, 18.8; survivors mean, 12.7; p < 0.001), and also presented higher scores in Marshall CT classification (nonsurvivors mean, 4.6; survivors mean, 2.7; p < 0.05). There was a significant positive correlation between plasma levels at second plasma sampling and scores in Marshall CT classification (p < 0.05). The sensitivity of plasma VWF concentration in predicting mortality according to the cut-off of 234 U/dL was 64%, with a specificity of 68%. Therefore, VWF increases following severe TBI may be a marker of unfavorable outcome.

The Temporal Pattern of Changes in Serum Biomarker Levels Reveals Complex and Dynamically Changing Pathologies after Exposure to a Single Low-Intensity Blast in Mice

“…Similar to VEGF, vWF is also involved in the regulation of angiogenesis, cell proliferation, and inflammation (61). Elevated vWF serum level is an indicator of increased vascular permeability in various disease conditions and of unfavorable outcome in TBI (62). Increased vWF serum levels have also been found in systemic inflammation (63, 64).…”

Traumatic Brain Injury-Associated Coagulopathy

“…For example, VWF is widely used as a marker for endothelial injury, 63,64 but its change in its adhesion activity and contribution to coagulopathy in TBI are not known. VWF mediates the initial tethering of platelets to perturbed endothelium or subendothelial matrix exposed at sites of vascular injury.…”

“…First, the secretion of ULVWF is significantly increased in traumatic injury, including TBI. 63,64 Second, ADAMTS-13 activity is reduced in traumatic and surgical injury. Third, intravascular thrombosis developed in the lesion boundary zone contained a substantial amount of VWF and platelets in a rat model of controlled cortical injury.…”

Neurotrauma: The Crosstalk between Neurotrophins and Inflammation in the Acutely Injured Brain

“…Among the most studied predictors of outcome after severe TBI, age is a consistent predictor, as well as GCS scores and pupillary parameters [4]. Moreover, recent studies show a series of blood biomarkers that are useful in the clinical status evaluation of these patients, such as protein S100B and neuron-specific enolase [13,14,15,16] among a number of promising new candidates [13,14,17,18,19,20,21,22,23]. Thus, establishing the real burden of TBI remains challenging because of its heterogeneity in terms of pathobiology, clinical presentation, and outcome (mortality rates range from less than 1% in mild TBI to up to 50% in severe TBI) [24,25,26].…”